All about breast augmentation

Breast enlargement surgery, also known as breast augmentation or augmentation mammoplasty, involves the insertion of an artificial implant behind the breast to increase its size.

Why is breast enlargement done?
This procedure is done primarily for cosmetic reasons. A woman may feel her breasts are disproportionately small in relation to the rest of her body, or that one breast is noticeably small compared with the other. Some women wish to have the procedure because of diminished breast size after pregnancy, or after breast removal surgery.

Many women have reduced self-esteem and feel sexually inhibited or less feminine because of their small breasts. Although it can be argued that having breast enlargement done is giving in to societal pressure to conform to ideals of beauty and sexuality, for some women, concern over their breast size can have a major negative impact on their quality of life.

Who is a suitable candidate for breast augmentation?
Most women who wish to have breast enlargement surgery are able to, but the best candidates are those who wish to achieve improvement, rather than perfection, in their appearance, and therefore have realistic expectations about the operation. Your surgeon also needs to be satisfied that you are in good health and able to undergo surgery.

How is breast enlargement done?

The enlargement is achieved by inserting an artificial implant behind each breast. The implant is a silicone shell filled with either silicone gel or saline.

The surgical incision is placed to make scars unobtrusive: in the crease where the breast meets the chest, around the nipple or in the armpit. The surgeon then creates a pocket, either directly behind the breast tissue or beneath the chest wall muscle, to contain the implant.

 Placing the implant behind the chest muscle has the potential advantage of reducing the risk of capsular contracture (See ‘What are the risks?’), and interfering less with mammograms than if the implant is placed directly behind the breast tissue. Placement behind the muscle may cause more post-operative pain, however.

Breast augmentation is usually performed with general anaesthesia, although some surgeons use a local anaesthetic combined with a sedative. The surgery takes about one to two hours.

There will be discomfort for a few days after surgery, but this is generally well controlled with pain medication, and most patients can return to work within the week. It takes several weeks for the pain and swelling to subside, however, and strenuous activity and physical contact to the chest should be avoided for about a month. It takes several months for the scars to become less perceptible.

What are the risks?
Most breast augmentation operations are straight forward and without complications, but, as with any surgery, there are associated risks.

There are also specific complications associated with this procedure, the most common being capsular contracture. This is when the scar or capsule starts to contract around the implant, causing the breast to feel hard. This isn’t a health risk, but it does cause aesthetic problems and may require removal of the scar tissue, or replacement of the implant.

A few women develop an infection around the implant. Sometimes, the implant must be removed for several months until the infection resolves. Some women lose sensation in their nipples, or around the incisions, or they find that their nipples become overly sensitive.

The main concern most people have is the possibility of breast implants breaking and their contents leaking into the body, as there have been many reports in the media in recent years about the possible link between silicone implants and diseases like cancer and immune conditions.

However, the current consensus by most medical scientists is that these fears are quite unfounded, as there is no evidence that breast implants increase a woman’s risk for any disease, and nor do they affect fertility, prevent breast-feeding, or delay diagnosis of breast cancer.

Occasionally implants do break as a result of injury or even normal movement. If a saline-filled implant breaks, the salt water is harmlessly absorbed by the body. If a gel-filled implant breaks, the gel may move into the surrounding breast tissue, or may migrate to another area of the body. This may result in a change in the shape or firmness of the breast, and require a second operation and implant replacement. In some cases, it is not possible to remove all of the gel from the breast tissue.

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